IE (Ireland) Core Implementation Guide - Local Development build (v0.3.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

EHDS & EU Conformance

EHDS & EU Conformance

The IE Core Implementation Guide is designed to ensure conformance with the European Health Data Space (EHDS) and enable cross-border interoperability across EU Member States. IE Core provides dedicated profiles for all five EHDS priority data categories.

Layered Architecture

IE Core follows the layered FHIR profile architecture established by HL7 Europe:

┌──────────────────────────────────────────────────────────┐
│         IE Core Profiles (Irish)                         │  ← This IG
│  Irish identifiers, HSE schemes, Eircodes, PCRS         │
├──────────────────────────────────────────────────────────┤
│  HL7 Europe Scoped IGs                                   │
│  MPD, Laboratory, Patient Summary, HDR, Imaging          │
├──────────────────────────────────────────────────────────┤
│  HL7 Europe Core Profiles (EU)            hl7.fhir.eu.base│
│  EHDS-aligned, cross-border constraints                  │
├──────────────────────────────────────────────────────────┤
│  HL7 Europe Base Profiles (EU)            hl7.fhir.eu.base│
│  Loosely constrained European concepts                   │
├──────────────────────────────────────────────────────────┤
│  International Patient Summary (IPS)      hl7.fhir.uv.ips │
│  Universal cross-border patient summary                  │
├──────────────────────────────────────────────────────────┤
│  FHIR R4 Base Resources                                  │
│  HL7 FHIR standard resource definitions                 │
└──────────────────────────────────────────────────────────┘

EU Dependencies

The following EU IGs are formal dependencies of IE Core:

The following EU IGs have new QA Preview versions or are in active development:

For the complete HL7 Europe EHDS IG listing, see the HL7 Europe Confluence page.

HL7 Europe EHDS Implementation Guides Reference

EHDS Five Priority Categories

The EHDS regulation identifies five priority categories for the European Electronic Health Record Exchange Format (EEHRxF). IE Core provides dedicated profiles for each:

1. Patient Summary

The IE Core Patient Summary profile structures essential clinical information using the IPS section model (medications, allergies, problems, procedures, immunizations, results, vital signs) for both domestic continuity of care and cross-border exchange via MyHealth@EU.

2. ePrescription & eDispensation

Irish ePrescription and eDispensation (the HIQA Draft National Standard for Electronic Prescriptions and Electronic Dispensations, HL7 Europe MPD, cross-border ePrescription) are profiled in IE Medication Events (nostalgic-ie.fhir.medication-events), not in IE Core (ADR-009).

3. Laboratory Results

The IE Core Laboratory Report profile is aligned with the published HL7 Europe Laboratory Report IG (STU 2.0, Jun 2026). It supports laboratory reporting workflows for clinical biochemistry, haematology, microbiology, immunology, and other in-vitro diagnostic disciplines.

4. Hospital Discharge Report

The IE Core Hospital Discharge Report provides a structured Composition with sections for admission details, discharge diagnoses, procedures, medications, allergies, and post-discharge care plans. IE Core now depends on the published hl7.fhir.eu.hdr@0.1.0-ballot package for the current HDR aliases. Full re-parenting follows the next published EU HDR IG update.

5. Medical Images & Reports

The HL7 Europe Imaging IG (hl7.fhir.eu.imaging) is currently in ballot (Mar–Apr 2026) for both R4 and R5 versions. The ballot covers:

• ImagingReport — structured radiology/pathology reports
• ImagingStudy — DICOM study metadata
• MADO (Manifest-Based Access to DICOM Objects) — imaging manifest for cross-border access

IE Core currently provides the IE Core DiagnosticReport (Note) profile as baseline imaging report support. Full ImagingStudy and ImagingReport profiles will be added as a formal dependency once the HL7 Europe Imaging IG is published.

Xt-EHR Logical Model Alignment Matrix

The following table maps Xt-EHR EHDS logical information models (v1.0.0) to IE Core FHIR profiles. The "R4 Mapping" column notes where the FHIR R4 resource differs from the FHIR R5 resource used in the XT-EHR authoring environment. The "Obligations" column indicates whether IE Core currently satisfies the XT-EHR v1.0.0 Obligations layer for that model.

Note on FHIR version: XT-EHR v1.0.0 logical models are authored in FHIR R5 (fhirVersion: 5.0.0). IE Core uses FHIR R4 (fhirVersion: 4.0.1). The logical models themselves are FHIR-version-agnostic (they use the Logical: keyword and reference abstract types), but the FHIR resource mappings differ for some models. See FHIR R4/R5 Compatibility below.

FHIR R4/R5 Compatibility

XT-EHR v1.0.0 logical models are authored as FHIR R5 artefacts. IE Core is a FHIR R4 IG. The logical models themselves are FHIR-version-agnostic by design — they use the Logical: construct and abstract base types. However, when mapping logical models to concrete FHIR resource profiles, the following R4/R5 differences are relevant:

Conclusion: All XT-EHR 1.0.0 logical model concepts can be represented in FHIR R4, but implementers targeting FHIR R5 will need to use different resource types for EHDSMedicationUse and EHDSDeviceUse. When IE Core migrates to FHIR R5 (planned for EU Core 3.x alignment), these profiles will need to be re-parented to the R5 resource types.

Obligations Framework (New in XT-EHR v1.0.0)

XT-EHR v1.0.0 introduced a formal Obligations Framework — a separate layer of derived logical models that specify normative obligations (SHALL/SHOULD/MAY) for each actor (creator, repository, consumer) across each use case. This is a significant addition not present in v0.3.0.

The Obligations Framework defines ~30 Obligations models (e.g., EHDSPatientSummaryObligations, EHDSDischargeReportObligations) that reference the parent logical models and add formal requirements per actor per element.

IE Core Obligations Coverage:

What Obligations compliance means for IE Core implementers:

• Systems implementing IE Core SHOULD consult the XT-EHR Obligations models to understand which elements are mandatory for specific actors
• Creator systems must populate all SHALL elements before sending; Consumer systems must be able to process all SHALL elements on receipt
• IE Core profiles set MS (Must Support) flags on elements that correspond to SHALL obligations in the XT-EHR model
• Where XT-EHR obligations require elements not available in FHIR R4, IE Core documents the limitation and provides the closest R4 equivalent

Profile Derivation Map

Currently Derived from EU Core (v2.0.0)

Planned Migration to EU Core (v2.0.0)

Cross-Border Interoperability (MyHealth@EU)

Ireland participates in the MyHealth@EU infrastructure. IE Core supports the following MyHealth@EU services:

Cross-border ePrescription and eDispensation are covered by IE Medication Events (ADR-009).

EHDS Regulation Alignment

Primary Use (Care Delivery)

• Patient Summary: Structured IPS-compatible composition for unplanned and planned care
• ePrescription/eDispensation: profiled in IE Medication Events (ADR-009)
• Laboratory Results: Structured lab reports with EU Lab IG alignment
• Hospital Discharge: Composition-based discharge summaries
• Imaging: Baseline support via DiagnosticReport; full ImagingStudy planned

Secondary Use (Research & Policy)

• Standardized Coding: SNOMED CT, LOINC, ATC, ICD-10 enable aggregation and research
• Structured Data: Machine-readable FHIR representation for health data reuse
• Provenance: IE Core Provenance profile tracks data origin and transformations

Irish-Specific Extensions for Cross-Border

IE Core adds the following Ireland-specific elements on top of the EU profiles:

These extensions ensure that cross-border systems can distinguish Irish-origin data and map identifiers appropriately.

eIDAS 2.0 and EUDI Wallet — FHIR Mapping

eIDAS Cross-Border Patient Identifier

The eIDAS cross-border patient identifier uses the format Origin/Destination/NationalID (e.g. IE/DE/1234567T). In IE Core, this is represented in Patient.identifier with the eHDSI-defined OID system URI:

EUDI Wallet Person Identification Data (PID)

eIDAS 2.0 (Regulation 2024/1183/EU) introduces the EU Digital Identity (EUDI) Wallet and the Person Identification Data (PID) attestation set, defined in the EUDI Architecture and Reference Framework (ARF). The following table maps EUDI PID attributes to IE Core FHIR elements:

FAPI 2.0 and EHDS Health Data API

The EHDS Regulation 2025/327 and the HL7 Europe Health Data API IG (hl7.fhir.eu.health-data-api) mandate high-assurance API security for EHDS data spaces. IE Core implementations supporting EHDS secondary use data access SHOULD implement:

FAPI 2.0 references:

• FAPI 2.0 Security Profile
• HL7 Europe Health Data API IG

Future EU Alignment

XT-EHR v1.0.0 was published in 2025. As the EHDS ecosystem evolves towards the March 2027 implementing acts deadline, IE Core will:

1. Re-parent to EU Core v2.0 for AllergyIntolerance, Condition, Procedure, Immunization, Medication, DiagnosticReport (currently on EU Core v2.0)
2. Adopt EU Patient Summary IG when hl7.fhir.eu.eps@1.0.0 stabilizes — currently testing QA Preview 1.0.0-alpha (Xt-EHR Projectathon, Jun 2026); full re-parenting planned on STU publication
3. Adopt EU Hospital Discharge IG when hl7.fhir.eu.hdr@1.0.0 stabilizes — currently testing QA Preview 1.0.0-alpha (Xt-EHR Projectathon, Jun 2026); full re-parenting planned on STU publication
4. Add Imaging profiles once hl7.fhir.eu.imaging is published (Ballot 1.0.0, Jun 2026); will add ImagingStudy and ImagingReport profiles and formal dependency to v1.0.0
5. Add Health Data API conformance once hl7.fhir.eu.health-data-api is published (Ballot 1.0.0, Jun 2026); implement FAPI 2.0 requirements for EHDS secondary use
6. Implement XT-EHR Obligations compliance — formally adopt the Obligations Framework from XT-EHR 1.0.0 as EU IGs incorporate them; near-term milestone is full obligation compliance for PS and HDR
7. Support FHIR R5 following HL7 Europe's R5 timeline — requires re-mapping MedicationStatement→MedicationUsage, DeviceUseStatement→DeviceUsage, and Consent restructure
8. Implement EUDI Wallet integration — align cross-border patient authentication with EUDI Wallet PID attestations per eIDAS 2.0 (Regulation 2024/1183/EU) and EUDI ARF v2.x; targeted for 2026 MyHealth@EU integration